SciCombinator

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Concept: Parasitic worm

173

Understanding the global limits of transmission of soil-transmitted helminth (STH) species is essential for quantifying the population at-risk and the burden of disease. This paper aims to define these limits on the basis of environmental and socioeconomic factors, and additionally seeks to investigate the effects of urbanisation and economic development on STH transmission, and estimate numbers at-risk of infection with Ascaris lumbricoides, Trichuris trichiura and hookworm in 2010.

Concepts: Disease, Infection, Nematodes, Whipworm, Hookworm, Parasitic worm, Parasitic animals, Ascaris lumbricoides

169

Hookworms infect more people than HIV and malaria combined, predominantly in third world countries. Treatment of infection with chemotherapy can have limited efficacy and re-infections after treatment are common. Heavy infection often leads to debilitating diseases. All these factors suggest an urgent need for development of vaccine. In an attempt to develop a vaccine targeting the major human hookworm, Necator americanus, a B-cell peptide epitope was chosen from the apical enzyme in the hemoglobin digestion cascade, the aspartic protease Na-APR-1. The A(291)Y alpha helical epitope is known to induce neutralizing antibodies that inhibit the enzymatic activity of Na-APR-1, thus reducing the capacity for hookworms to digest hemoglobin and obtain nutrients. A(291)Y was engineered such that it was flanked on both termini by a coil-promoting sequence to maintain native conformation, and subsequently incorporated into a Lipid Core Peptide (LCP) self-adjuvanting system. While A(291)Y alone or the chimeric epitope with or without Freund’s adjuvants induced negligible IgG responses, the LCP construct incorporating the chimeric peptide induced a strong IgG response in mice. Antibodies produced were able to bind to and completely inhibit the enzymatic activity of Na-APR-1. The results presented show that the new chimeric LCP construct can induce effective enzyme-neutralising antibodies in mice, without the help of any additional toxic adjuvants. This approach offers promise for the development of vaccines against helminth parasites of humans and their livestock and companion animals.

Concepts: Immune system, Protein, Bacteria, Anemia, Dog, Hookworm, Parasitic worm, Necator

167

BACKGROUND: In the first part of this study, we investigated the prevalence and associated key factors of soil-transmitted helminth (STH) infections among Orang Asli children in rural Malaysia; an alarming high prevalence and five key factors significantly associated with infections were reported. Part 2 of this study aims to evaluate the knowledge, attitude and practices (KAP) on STH infections among Orang Asli in Peninsular Malaysia. METHODS: A cross-sectional study was carried out among 215 households from 13 villages in Lipis district, Pahang, Malaysia. Demographic and socioeconomic information of the participants and their KAP on STH were collected by using a pre-tested questionnaire. RESULTS: Overall, 61.4% of the participants had prior knowledge about intestinal helminths with a lack of knowledge on the transmission (28.8%), signs and symptoms (29.3%) as well as the prevention (16.3%). Half of the respondents considered STH as harmful, while their practices to prevent infections were still inadequate. Significant associations between the KAP and age, gender, educational and employment status, family size, and household monthly income were reported. Moreover, significantly lower prevalence of STH infections was reported among children of respondents who wear shoes/slippers when outside the house (72.8%; 95% CI= 62.6, 80.5 vs 87.0%; 95% CI= 81.4, 91.1), wash their hands before eating (32.4%; 95% CI= 24.3, 42.2 vs 51.4%; 95% CI= 44.7, 60.1), and wash their hands after defecation (47.8%; 95% CI= 35.7, 57.1 vs 69.2%; 95% CI= 63.7, 78.7) as compared to their counterparts. Multiple logistic regression analysis indicated that the educational level of the respondents was the most important factor significantly associated with the KAP on STH among this population. CONCLUSION: This study reveals inadequate knowledge, attitude and practices on STH infections among Orang Asli in rural Malaysia. Hence, there is a great need for a proper health education programme and community mobilisation to enhance prevention and instil better knowledge on STH transmission and prevention. This is crucial for an effective and sustainable STH control programme to save the lives and future of the most vulnerable children in rural Malaysia.

Concepts: Regression analysis, Logistic regression, Intestinal parasite, Hookworm, Parasitic worm, Orang Asli, Pahang, Kelantan

165

BACKGROUND: The prevalence of infection with the three common soil-transmitted helminths (i.e. Ascaris lumbricoides, Trichuris trichiura and hookworm) in Bolivia is among the highest in Latin America. However, the spatial distribution and burden of soil-transmitted helminthiasis are poorly documented. METHODS: We analysed historical survey data using Bayesian geostatistical models to identify determinants of the distribution of soil-transmitted helminth infections, predict the geographical distribution of infection risk, and assess treatment needs and costs in the frame of preventive chemotherapy. Rigorous geostatistical variable selection identified the most important predictors of A. lumbricoides, T. trichiura and hookworm transmission. RESULTS: Results show that precipitation during the wettest quarter above 400 mm favours the distribution of A. lumbricoides. Altitude has a negative effect on T. trichiura. Hookworm is sensitive to temperature during the coldest month. We estimate that 38.0%, 19.3% and 11.4% of the Bolivian population is infected with A. lumbricoides, T. trichiura and hookworm, respectively. Assuming independence of the infections, 48.4% of the population is infected with any soil-transmitted helminth. Empirical-based estimates, according to treatment recommendations by the World Health Organization, suggest a total of 2.9 million annualised treatments for the control of soil-transmitted helminthiasis in Bolivia. CONCLUSIONS: We provide estimates of soil-transmitted helminth infections in Bolivia based on high-resolution spatial prediction and an innovative variable selection approach. However, the scarcity of the data suggests that a national survey is required for more accurate mapping that will govern spatial targeting of soil-transmitted helminthiasis control.

Concepts: Infection, Prediction, Transmission and infection of H5N1, Nematodes, Whipworm, Hookworm, Parasitic worm, Parasitic animals

133

The human intestine and its microbiota is the most common infection site for soil-transmitted helminths (STHs), which affect the well-being of ~ 1.5 billion people worldwide. The complex cross-kingdom interactions are not well understood.

Concepts: Bacteria, Intestinal parasite, Parasitic worm

93

Infection with intestinal helminths results in immunological changes that influence co-infections, and might influence fecundity by inducing immunological states affecting conception and pregnancy. We investigated associations between intestinal helminths and fertility in women, using 9 years of longitudinal data from 986 Bolivian forager-horticulturalists, experiencing natural fertility and 70% helminth prevalence. We found that different species of helminth are associated with contrasting effects on fecundity. Infection with roundworm (Ascaris lumbricoides) is associated with earlier first births and shortened interbirth intervals, whereas infection with hookworm is associated with delayed first pregnancy and extended interbirth intervals. Thus, helminths may have important effects on human fertility that reflect physiological and immunological consequences of infection.

Concepts: Intestinal parasite, Fertility, Nematodes, Hookworm, Parasitic worm, Parasitic animals, Pinworm, Ascaris lumbricoides

58

We created a mobile phone microscope and assessed its accuracy for the diagnosis of soil-transmitted helminths compared with conventional microscopy. Mobile phone microscopy has a sensitivity of 69.4% for detecting any helminth egg and sensitivities of 81.0%, 54.4%, and 14.3% for the diagnosis of Ascaris lumbricoides, Trichuris trichiura, and hookworm, respectively.

Concepts: Nematodes, Mobile phone, Whipworm, Hookworm, Parasitic worm, Parasitic animals

27

Solid evidence regarding the epidemiology of intestinal helminth infections in Tajikistan is currently lacking. As such information is essential for the evidence-based design, implementation and evaluation of control interventions, a national intestinal helminth survey was conducted with the following objectives: i) to assess the prevalence of intestinal helminth infections among school-aged children nationally and stratified by region; ii) to identify locally relevant risk factors for infection; and iii) to better understand the children’s knowledge and perception of intestinal helminth infections, and asses their haemoglobin status. Standard field and laboratory procedures including the Kato-Katz thick smear and tape test were employed. Complete data was obtained for 1642 children from 33 randomly selected primary schools from different parts of the country. Across the country, prevalences of E. vermicularis, A. lumbricoides, H. nana and T. trichiura were 26.5%, 16.9%, 15.5% and 2.7% respectively. The prevalence of common soil-transmitted helminth (A. lumbricoides and T. trichiura) infections was 19.4%. No hookworm infections were detected, and prevalences of various infections differed significantly between administrative districts (all P<0.05). Hand washing after toilet usage (OR=0.78; P=0.047) and handling animals (OR=0.66; P=0.009) were identified as significant protective factors against E. vermicularis infections. H. nana infection was associated with a 2.85g/L decrease in haemoglobin levels (P<0.001) despite already low average haemoglobin levels. The proportions of children with knowledge about intestinal helminths and protective hygiene practices varied significantly between regions (both P<0.001). Mass albendazole administration to school-aged children and women of child-bearing age against intestinal helminths has now been initiated in Tajikistan, to be followed by mass albendazole and praziquantel distribution to school-aged children. In the longer term, an integrated approach including chemotherapy, provision of safe water and proper sanitation as well as targeted health education will be necessary to achieve sustainable control.

Concepts: Disease, Intestinal parasite, Hygiene, Hookworm, Parasitic worm, Parasitic animals, Pinworm, Helminthology

15

Quantifying the burden of parasitic diseases in relation to other diseases and injuries requires reliable estimates of prevalence for each disease and an analytic framework within which to estimate attributable morbidity and mortality. Here we use data included in the Global Atlas of Helminth Infection to derive new global estimates of numbers infected with intestinal nematodes (soil-transmitted helminths, STH: Ascaris lumbricoides, Trichuris trichiura and the hookworms) and use disability-adjusted life years (DALYs) to estimate disease burden.

Concepts: Disease, Infection, Intestinal parasite, Nematodes, Hookworm, Parasitic worm, Parasitic animals, Pinworm

10

Immunity to intestinal helminth infections has been well studied, but the mechanism of helminth killing prior to expulsion remains unclear. Here we identify epithelial-cell-derived phospholipase A2 group 1B (PLA2g1B) as a host-derived endogenous anthelmintic. PLA2g1B is elevated in resistant mice and is responsible for killing tissue-embedded larvae. Despite comparable activities of other essential type-2-dependent immune mechanisms, Pla2g1b(-/-) mice failed to expel the intestinal helminths Heligmosomoides polygyrus or Nippostrongylus brasiliensis. Expression of Pla2g1b by epithelial cells was dependent upon intestinal microbiota, adaptive immunity, and common-gamma chain-dependent signaling. Notably, Pla2g1b was downregulated in susceptible mice and inhibited by IL-4R-signaling in vitro, uncoupling parasite killing from expulsion mechanisms. Resistance was restored in Pla2g1b(-/-) mice by treating infective H. polygyrus L3 larvae with PLA2g1B, which reduced larval phospholipid abundance. These findings uncover epithelial-cell-derived Pla2g1b as an essential mediator of helminth killing, highlighting a previously overlooked mechanism of anti-helminth immunity.

Concepts: Immune system, Bacteria, Intestinal parasite, Parasitic worm